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SCIENCE & TECHNOLOGY
Managing The Brain
How implanted devices could enhance memory, reduce migraine and sort out a host of other problems. Chitra Narayanan reports
16 March 2009
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| Picture courtesy: Medtronic |
In the 1994 cyberpunk movie Johnny Mnemonic, Keanu Reaves plays a data trafficker who has data implanted in the safest place possible — his brain. Trouble is his brain has only 80 gigabytes of data space and even with memory enhancement, can go up to only 160 gigabytes, after which if loaded further will crash.
Circa 2009. Synthetic neurobiology researchers at MIT are pondering if technologies like deep brain stimulation (DBS) could possibly lead to memory enhancement of the brain. “We know that a single electrode inserted into the brain can cause unknown cellular effect,” says Vinay Gidwaney, software wizard, and MIT Media Lab researcher who is now engaged in writing programmes that could potentially alter brain functions. Neurotechnology research has advanced to such an extent that science fiction is now threatening to collide with the real world.
While some of the potential applications of this research that Gidwaney mentions — memory enhancement, telepathy, mind reading — are still debatable, technologies like DBS and neuromodulation are already yielding possible cures for brain related ailments that an estimated 1.5 billion people across the world suffer from. These include not just disorders like Parkinson's, Alzheimers, Multiple Schlerosis and epilepsy, but also sleep disorder, obesity, migraine, headache and even addictions like cigrarette smoking or drinking.
And don’t think the action is all that far away — some of it is happening right here on our shores. For instance, last year in Mumbai, Jaslok Hospital, Dr Paresh Doshi, a functional and stereotactic neurosurgeon, implanted a brain pacemaker in a 42-year old businessman to give relief to his migraine. Basically, the device sends electrical impulses which stimulate the greater occipital nerve, which runs along the back of the head on either side. The occipital nerve converges in the cervical spinal cord with the trigeminal system, which is responsible for conveying much of the throbbing pain associated with migraine. By stimulating this, the device short circuits the migraine causing system.
“The beauty of this therapy is that it is safe and reversible and also gives us great flexibility in managing the amount of current,” says Doshi. As he points out, in pills, you don’t have much control over doses, you could reduce it by half a pill perhaps. But by the electrode or continuous current, there is great titrability. In other words, you deliver the amount of current required to individual needs — perhaps one-fifteenth the amount in somebody,” says Doshi.
Apart from greater occipital nerve stimulation, another new approach in migraine management is the non-invasive transcranial magnetic stimulation, where a magnetic device is pressed to the back of the head and brief pulses are delivered, altering electrical activity inside the brain. The same method can be used to treat patients recovering from stroke.
Roughly 240 million people across the world suffer from migraine. In India, 15-20% of people are estimated to suffer from migraine, and this usually afflicts more women.
| Driving Away The Blues By Changing Circuits |
Over 240 million people world over suffer from depression. In India, a significant number of people are in the grip of the blues. Valuable workdays are lost because a young healthy person can’t cope with depression. So, can surgery be used to treat psychiatric disorders in India?
A landmark meeting in Mumbai, which concluded on 8 March, has laid down the guidelines for neurosurgery to treat psychiatric disorders. Twenty top psychiatrists from the country attended the meeting in Mumbai, convened by noted neurosurgeon Dr Paresh Doshi to define guidelines, indications, and follow up protocols for surgical options for patients suffering from psychiatric disorders.
“It’s a landmark meeting,” says Doshi, who says it will pave the way for using deep brain stimulation techniques to find a cure for treatment-resistant psychiatric problems like Obsessive Compulsive Disorders (OCD) in India. Already several western countries, notably Scandinavian countries have taken a lead in this area.
“Think of the productivity gains if even 2 per cent of the individuals suffering from such disorders can be treated in this manner and rehabilitated back in the workforce,” says Doshi, arguing that benefits far outweigh costs incurred on such treatment.
According to MIT Media Lab researcher Vinay Gidwaney, huge advances in functional imaging techniques such as FMRI, PET, EEG and MEG have led researchers to understand the neural circuitry underlying psychiatric disease. As imaging advances further, and an even clearer picture of how the circuits can be manipulated emerges, one can look forward to pathbreaking advances in treating diseases which on the surface have nothing to do with the brain — cancer, for instance. |
But migraine remedy is not the only neuromotor stimulation application — as Doshi points out, today, right here in India we have performed landmark implants for various ailments, ranging from Parkinson's to chronic pain management. He describes how for chronic pain, a condition like FBSS (failed back surgery syndrome) for instance, an electrode is implanted over spinal cord, outside the dura (the covering over spinal cord). The electrode emits a signal which blocks the pain signal. “We are basically jamming the signal going into the brain,” says Doshi.
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